Citation: Journal of the Royal Society of Medicine. 2014 Nov 11. pii: 0141076814557301. [Epub ahead of print]
Author: Ahmad N, Thomas GN, Gill P, Chan C, Torella F
Abstract: OBJECTIVE: We describe the prevalence of major lower limb amputation across
England and its relationship with revascularisation, patient demography and
disease risk factors.
DESIGN: Retrospective cohort study.
SETTING: England
1 April 2003 to 31 March 2009.
PARTICIPANTS: Patients aged 50-84
years.
MAIN OUTCOME MEASURES: Age standardised prevalence rates were
calculated using Hospital Episode Statistics as the numerator with census data
as the denominator. The outcome measure 'amputation with revascularisation' was
created if an amputation could be linked with a revascularisation. Logistic
regression determined the odds of having an amputation with a revascularisation
across England. Regression was performed unadjusted and repeated after
controlling for demographic (age, sex, social deprivation) and disease risk
factors (diabetes, hypertension, coronary heart disease, cerebrovascular
disease, smoking).
RESULTS: There were 25,312 amputations and 136,215
revascularisations, and 7543 cases were linked. The prevalence rate per 100,000
(95% confidence intervals) for amputation was 26.3 (26.0-26.6) with rates
significantly higher in Northern England (North: 31.7; 31.0-32.3, Midlands:
26.0; 25.3-26.7, South: 23.1; 22.6-23.5). The revascularisation rate was 141.6
(140.8-142.3) with significantly higher rates again in Northern England (North:
182.1; 180.5-183.7, Midlands: 121.3; 119.8-122.9, South 124.9; 123.9-125.8). The
odds of having an amputation with a revascularisation remained significantly
higher in the North (OR 1.22; 1.13-1.33) even after controlling demographic and
disease risk factors.
CONCLUSIONS: There is a North-South divide in England
for both major lower limb amputation and revascularisation. The higher odds of
having an amputation with a revascularisation in the North were not fully
explained by greater levels of deprivation or disease risk factors.
Link to PubMed record.
